Gulizia J M, Engel P J, McManus B M
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68198-6495.
J Heart Lung Transplant. 1993 May-Jun;12(3):372-80.
Heart transplantation as a treatment for end-stage heart failure has spawned numerous important challenges in patient care. A heart transplant patient with clinically unsuspected acute rheumatic carditis had an ultimately fatal course marked by refractory rejection and early death after transplantation. The patient had several immune abnormalities. Peripheral blood T lymphocytes (CD2+) were significantly elevated (p < 0.05) by flow cytometry in active rheumatic carditis versus 76 healthy individuals. The CD4+:CD8+ T-cell ratio was 5.5:1 in rheumatic disease and only 2.7:1 in healthy individuals. Numbers of peripheral blood B lymphocytes (CD19+), macrophages (CD14+), and interleukin-2 receptor-positive cells (CD25+) were also elevated in rheumatic disease. Natural killer cells (CD16+) were slightly reduced in number and appeared functionally deficient, and antibody-dependent cellular cytotoxicity was also reduced. Immunohistochemically, infiltrating cells in Aschoff lesions of the rheumatic native heart were mainly T cells, with putative TH/I cells predominating. The striking immune accompaniments of acute rheumatic fever may have heralded profound immune-mediated allograft intolerance leading to the patient's demise. Considering the recrudescence of rheumatic heart disease in this country and its remaining worldwide importance, such patients as the one discussed offer daunting clinical challenges when transplantation is an obvious management choice for severe, end-stage dilated cardiomyopathy.
心脏移植作为终末期心力衰竭的一种治疗方法，在患者护理方面引发了众多重大挑战。一名患有临床未被怀疑的急性风湿性心内膜炎的心脏移植患者，其最终病程以难治性排斥反应和移植后早期死亡为特征。该患者存在多种免疫异常。与76名健康个体相比，在活动性风湿性心内膜炎患者中，通过流式细胞术检测发现外周血T淋巴细胞（CD2 +）显著升高（p < 0.05）。在风湿性疾病患者中，CD4 +:CD8 + T细胞比值为5.5:1，而在健康个体中仅为2.7:1。风湿性疾病患者外周血B淋巴细胞（CD19 +）、巨噬细胞（CD14 +）和白细胞介素 - 2受体阳性细胞（CD25 +）的数量也有所升高。自然杀伤细胞（CD16 +）数量略有减少且功能似乎存在缺陷，抗体依赖性细胞毒性也降低。免疫组织化学显示，风湿性天然心脏阿绍夫小体中的浸润细胞主要是T细胞，以假定的TH/I细胞为主。急性风湿热显著的免疫伴随症状可能预示着严重的免疫介导的同种异体移植不耐受，导致了患者的死亡。考虑到该国风湿性心脏病的复发情况及其在全球范围内的持续重要性，对于像本文所讨论的这类患者，当移植是严重终末期扩张型心肌病的明显治疗选择时，会带来严峻的临床挑战。
